Healthcare Provider Details

I. General information

NPI: 1508979956
Provider Name (Legal Business Name): PALMETTO PEE DEE BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 05/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 GREGG AVE.
FLORENCE SC
29501-4316
US

IV. Provider business mailing address

2777 SPEISSEGGER DR
NORTH CHARLESTON SC
29405-8229
US

V. Phone/Fax

Practice location:
  • Phone: 843-669-6706
  • Fax: 843-669-5127
Mailing address:
  • Phone: 843-745-5122
  • Fax: 843-745-5170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License NumberRTF014
License Number StateSC

VIII. Authorized Official

Name: STEVE FILTON
Title or Position: SRVP CFO
Credential:
Phone: 610-768-3300